Data SourcesAgency for Healthcare Research and Quality

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Consumer Assessment of Healthcare Providers and Systems (CAHPS®)

Sponsor

U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ). Participating sponsors include State Medicaid agencies, State Children's Health Insurance Programs (SCHIP), public and private employers, individual health plans, Medicare, and the Department of Defense.

Mode of Administration

By responding to a standardized set of questions administered through a mail or telephone questionnaire, health plan members report on their experiences and rate their health plans and providers in several areas.

Survey Sample Design

CAHPS® surveys are administered to a random sample of health plan members by independent survey vendors, following standardized procedures.

Primary Survey Content

Consumer experiences in obtaining health care, including the following five major areas: getting needed care; getting care without long waits; how well doctors communicate; courtesy and helpfulness of office staff, and customer service.

Estimates for tables based on CAHPS® data were calculated using plan-level weights; i.e., all respondents in a plan received the same weight. Further, all plans within a State were weighted to contribute equally to the State-level statistic. CAHPS® data were provided by the National CAHPS® Benchmarking Database (NCBD).

The primary purpose of the NCBD is to facilitate comparisons of CAHPS® survey results by survey sponsors. By compiling survey results from a variety of sponsors into a single national database, the NCBD enables participants to compare their own results to relevant benchmarks. The NCBD also offers an important source of primary data for specialized research related to consumer assessments of quality as measured by CAHPS®.

The NCBD currently contains 8 years (1998-2005) of data from the CAHPS® Health Plan Survey. The 2005 database holds survey results for approximately 327,000 adults and children enrolled in commercial, Medicaid, SCHIP, and Medicare plans.

Reference

Healthcare Cost and Utilization Project (HCUP)

Sponsor

U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ).

Mode of Collection

HCUP databases bring together the data collection efforts of State government data organizations, hospital associations, private data organizations, and the Federal Government to create a national information resource of discharge-level health care data. The number of participating States increased to 37 in 2003. See "Sources of HCUP Data" below.

Sample Design

HCUP includes a collection of longitudinal hospital care data, with all-payer, discharge-level information beginning in 1988. Two HCUP discharge datasets were used in this report:

The HCUP Nationwide Inpatient Sample (NIS) is a nationally stratified sample of hospitals (with all of their discharges) from States that contribute data to the NIS dataset. Weights are used to develop national estimates. NIS 2003 contains data for approximately 7.9 million discharges from 994 hospitals located in 37 States, approximating a 20-percent stratified sample of U.S. community hospitals.

The 2003 HCUP Statewide Inpatient Databases (SID) include all hospitals (with all of their discharges) from 38 participating States. In aggregate, the SID represent approximately 90 percent of all U.S. hospital discharges, totaling over 34 million inpatient discharge abstracts.

Some NHDR measures that use HCUP data are based on the following AHRQ Quality Indicators:

Inpatient Quality Indicators (IQIs), which reflect quality of care in hospitals, include 13 mortality indicators for conditions or procedures for which mortality can vary from hospital to hospital; 9 utilization indicators for procedures for which utilization varies across hospitals or geographic areas; and 7 volume indicators for procedures for which outcomes may be related to the volume of those procedures performed.

Population Targeted

Any person, U.S. citizen or foreign, using non-Federal, non-rehabilitation, community hospitals in the United States as defined by the American Hospital Association (AHA).

The AHA defines community hospital as "all non-Federal, short-term, general, and other specialty hospitals, excluding hospital units of institutions." Included among community hospitals are specialty hospitals, such as obstetrics-gynecology, ear-nose-throat, short-term rehabilitation, orthopedic, and pediatric institutions. Also included are public hospitals and academic medical centers. The NIS and analyses of the SID for this report excluded short-term rehabilitation hospitals (beginning with 1998 data), long-term hospitals, psychiatric hospitals, and alcoholism/chemical dependency treatment facilities.

Although not all States participate in the HCUP database, the NIS is weighted to give national estimates using weights based on all U.S. community, non-rehabilitation hospitals in the American Hospital Association Annual Survey of Hospitals.

Demographic Data

Age, gender, race, insurance coverage, median household income of the patient's ZIP Code, urbanized location, and region of the United States.

Years Collected

Since 1988.

Schedule

Annual.

Geographic Estimates

National, four U.S. Census Bureau regions, and State levels (for States participating in SID).

Contact Information

References

Use of AHRQ Quality Indicator Software in Generating NHQR Tables

The following AHRQ QI software versions were used for generating the HCUP tables in this report: IQIs: Version 2.1, revision 3 (July 2004); PQIs: Version 2.1, revision 3 (January 2004); PSsI: Version 2.1, revision 2 (October 2004). For more information, see the methods section for each quality report, available at http://qualitytools.ahrq.gov.

Medical Expenditure Panel Survey (MEPS)

Sponsor

U.S. Department of Health and Human Services: Agency for Healthcare Research and Quality (AHRQ); and Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

Mode of Administration

MEPS comprises three component surveys: the Household Component (HC), the Medical Provider Component (MPC) and the Insurance Component (IC). The MEPS Household Component, the core survey, is an interviewer administered CAPI (computer assisted personal interview) household survey. The data for this report are primarily from the following sections of the 2000 and 2003 MEPS-HC.

Self-Administered Questionnaire (SAQ)

This self-administered paper questionnaire collects a variety of health and health care quality measures of adults. The health care quality measures in the SAQ were taken from the health plan version of CAHPS®, an AHRQ-sponsored family of survey instruments designed to measure quality of care from the consumer's perspective.

Diabetes Care Survey (DCS)

This self-administered paper questionnaire, given to persons identified as ever having had diabetes, asks about their diabetes care.

Child Health and Preventive Care (CHPR) section

Starting in 2001, a Child Health and Preventive Care section was added to the MEPS-HC interviews during the second half of the year. It included: health care quality measures taken from the health plan version of CAHPS®; the Children with Special Health Care Needs Screener questions; children's general health status as measured by several questions from the General Health Subscale of the Child Health Questionnaire; Columbia Impairment Scale questions about possible child behavioral problems; and child preventive-care questions. The CAHPS® questions and the Children with Special Health Care Needs Screener questions had been in a parent administered paper questionnaire (PAQ) in 2000. The PAQ estimates for 2000 may not be completely comparable to the CHPR estimates in later years due to differences in the administration of the PAQ and the CHPR section (parent self-administered paper questionnaire for the PAQ vs. interviewer-administered in-person household interview of household respondent for the CHPR).

Access to Care (AC)

The AC section of the MEPS-HC gathers information on five main topic areas: family members' origins and preferred languages; family members' usual source of health care; characteristics of usual source of health care providers; satisfaction with and access to the usual source of health care provider; and access to medical treatment, dental treatment, and prescription medicines.

Preventive Care (PC)

For each person, a series of questions was asked primarily about the receipt of preventive care or screening examinations.

Survey Sample Design

The sampling frame for the MEPS-HC is drawn from respondents to the National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics (NCHS). The MEPS-HC augments NHIS by selecting a sample of NHIS respondents; collecting additional data on their health care utilization, expenditures, sources of payment, quality, and insurance coverage; and linking these data with additional information from the respondents' medical providers, employers, and insurance providers.

Population Targeted

Like the NHIS population from which its subpopulation is drawn, the MEPS-HC is a nationally representative survey of the U.S. civilian noninstitutionalized population.

Demographic Data

The MEPS HC collects data on demographic characteristics including: age, gender, race, ethnicity, education, industry and occupation, employment status, household composition, and family income. Race and ethnicity variables and categories changed in 2002 to be compliant with Office of Management and Budget (OMB) standards that required changes by 2003. The race and ethnicity estimates starting in 2002 may not be completely comparable to estimates in prior years.

The residence location categories in the MEPS tables are based on the 2003 urban influence codes developed by the Department of Agriculture's Economic Research Service. The UIC form a 12-part county codification scheme for classifying standard OMB metropolitan counties by size and nonmetropolitan counties by size of the largest city or town as well as proximity to metropolitan and micropolitan areas. In the tables with four residence location categories, metropolitan counties are divided into large metropolitan and small metropolitan; nonmetropolitan counties are divided into micropolitan and noncore. In some tables, the noncore counties are further divided into noncore-adjacent and noncore-not adjacent; thus, these tables have five residence location categories. Note that noncore-not adjacent includes noncore counties adjacent to micropolitan areas that do not have their own town.

Years Collected

Schedule

Annual.

Geographic Estimates

National. The HC data also can be shown for the four Census Bureau regions (Northeast, Midwest, South, and West), as well as residence location status.

Notes

AHRQ fields a new MEPS panel each year. In this design, 2 calendar years of information are collected from each household in a series of five rounds of data collection over a 2½-year period. These data are then linked with additional information collected from the respondents' medical providers, employers, and insurance providers. This series of data collection activities is repeated each year on a new sample of households, resulting in overlapping panels of survey data.

Data Suppression

Estimates in the NHQR and NHDR detailed tables based on MEPS data are suppressed if the unweighted cell value is less than 100. Estimates are flagged if the relative standard error is greater than 30 percent.